Author Topic: What's wrong with memory tests  (Read 772 times)

Sunny Clouds

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What's wrong with memory tests
« on: 13 Aug 2022 12:01PM »
Five examples I give of why memory tests can leave a lot to be desired.  That doesn't mean they're useless, just that unless the psychiatrist or other person administering them is savvy, they can be inaccurate and that it's well worth giving an explanation of your answer or, if you're with someone else, explaining their answer.  Bear in mind that whilst they're characterised as 'memory' tests, they also test other things that are relevant.

1. Hearing

I had a memory test some years ago and the psychiatrist was asking me to remember three random words.   He had his back to a brightly lit window and he had some sort of African accent with very loose lip movements.  I asked him to repeat words, but you're not supposed to say them more than three times.  In the end I gave up and said if he couldn't be bothered to write them down or fingerspell them, I wasn't going to play guess the word.

Other issues such as problems with vision, speech etc. can be relevant, as can the use of English as a second language (which may not show from accent or nationality).


2. Familiarity/habit with question

I enjoyed a conversation on Facebook once.  I'll paraphrase it.

"I had a memory test today.  The doctor asked me to remember where John Smith lives.  Apparently, he still lives at 42 High Street, Manchester."
"When did he move there?  I'm sure my psychiatrist said he lived at 42 High Street, Cardiff."
"No, he lives at 42 High Street, Aberdeen."
"But I thought he still lived at 42 High Street, Cambridge."

The thread lasted a lot longer than that.  Lots of fun speculation about why John Smith keeps moving house. 


3. Familiarity/habit with task

Counting backwards in sevens is bog standard.  But there are two main problems with this that I can see. 

Firstly, if you haven't been asked to do this or haven't done it for years, it's a test of calculation and memory.  If you've been having memory tests for years, including before your memory started to go, it's a test of long-term memory.  Your line of work or social interests could be relevant to this. 

Secondly, some people actually do this to get to sleep.  No, really. Then you're checking what I think of as 'habitual memory'.  The backwards in sevens test would still be useful, just that the results would need to be interpreted differently.

That being said, slowness could be misinterpreted.  I'm obsessed with getting stuff right and checking it, so my instinct would be to work out the nearest multiple to a hundred, work out the difference, and count backwards by the familiar figures, adding on the difference.  An example - "Hmm, ten sevens are 70. That leaves 30. Four sevens are 28.  So each number I need is a multiple of seven, plus two.  Three sevens are 21, which, added to 70, gives me 91, so the next one down is 91 + 2 = 93."   

But what's being tested with me isn't what's being tested is if you think this way (which I suspect is more common)  "A hundred minus seven.  So I need 90 + (10-7) = 93."  Etc.


4. Social

I took Dad to a dementia clinic.  It was in a health clinic building he knew back to childhood.  To soothe him taking him there, I told him he was going for a 'free health test for elders' and that they'd probably check things like his memory.

When we got there, a young woman came out to fetch us and took us into a room and started asking questions.  She sounded a bit pushy.  She demanded of Dad "Do you know who I am?"  After a long pause, he said "I think the correct modern term would be senior executive."

I made an excuse to leave the room with her, telling Dad I needed to sort some administrative stuff.  In the next room, I pointed out to her that she hadn't introduced herself. She wasn't wearing a name badge or other clinical role indicator such as white coat or stethoscope.  I was guessing she was a doctor or nurse but I didn't actually know. 

I pointed out that the room had absolutely nothing in it to indicate that it was a clinical room.  However, my father had remembered that he was in a clinical building and his career had involved visiting hospitals in a formal capacity, being the VIP/bigwig. 

But she didn't introduce herself or brief him, so she wasn't a director or senior manager.  She came across like a jumped-up secretary as she demanded "Do you know who I am?" so whilst his memory mightn't be good, his logical deduction and manners were excellent and he'd given the socially correct response.


5. Not knowing what you're asking

A friend took her friend, whom I'll call Edna, to a memory test.  The psychiatrist did the usual pre-test waffle, then got started.

"So, Edna, when were you born?"
"1928."
"And who's the Queen?"
"Mary."

For some reason, the psychiatrist thought Edna had given the wrong answer and that the correct answer should be Elizabeth.  My friend and Edna are both historians, still actively interested in history in retirement, and both have a background in teaching, and put him right, parsing the question.

'Who' is a question word, asking for identity or translation.  Thus if someone asks "Who is the queen?" and we have a queen, it could be interpreted as asking for the name or other identifier, and whether or not we do, it could be interpreted as equivalent of "What is a queen?" prompting something like "Head of state" or "King's wife."

The question asked was "Who's..." That could be "Who is..." or "Who was...?"  If "Who is...?" it could refer to the past, which would be particularly common in certain sorts of documentary and narrative, where the past is spoken of in the present.  What my generation called the historic present.  (I think they call it something else now.)  Usage of present tense to indicate past in everyday speech varies massively according to things like social class, region etc. 

Normally, a "Who's...?" question would be interpreted as present tense, i.e. "Who is currently...?" but if there's a time indicator such as "These days, who's the queen..." then that should be taken into account.

And there was a time indicator "And."  The question was "And who's the queen?"  or, in other words, "Who's the queen in 1928?"  The correct answer therefore was Mary of Teck, who was queen and empress consort to George V from 1910 to 1936.


Conclusion

Don't write off memory tests as meaningless, just soothe friends and relatives if they're subjected to them badly, and clarify responses where helpful.  E.g. if you're asked something yourself, you might clarify with "Who was the queen in 1928?  That would have been Mary."

(Amended for typos not content.)
« Last Edit: 14 Aug 2022 02:53PM by Sunny Clouds »
(I'm an obsessive problem-solver, so feel free to ignore any suggestions or solutions I offer, even if they sound terribly insistent.)

Sunshine Meadows

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Re: What's wrong with memory tests
« Reply #1 on: 13 Aug 2022 01:09PM »
Interesting set of information which I can probably remember as long as no one mentions test or assessment.


I mentioned maybe CP causing me to have Oh man I am not kidding I cant remember what it is called it has to do with slow immediate processing. Anyway that and old family trauma means that if someone hurries me up to answer I often burble and stumble about. The weird thing is in the moment I am useless but afterwards memory and processing kick in and I can get my ducks in a row - too late.


I realise there are good reasons for memory tests in relation to dementia and head injuries but if I was asked to remember three things from one week to the next I would say can you write that down for me please?




Sunny Clouds

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Re: What's wrong with memory tests
« Reply #2 on: 13 Aug 2022 05:24PM »
Ah, but if it's psychiatric, there are resource shortages and time constraints and pathways (i.e. who's got the contract to provide what service) and box-ticking stereotypes.  (Yes, yes, I've got a thing about that, but then you all know I've a whole swarm of bees in my bonnet.)

My biggest problem dealing with psychiatry is that probably my biggest driver is the need to justify myself.  I'd say that comes from having a father for whom nothing was ever good enough, so I was forever justifying not being perfect, and a mother who for some reason seemed to disbelieve any aspect of ill-health.  (Well, except for bringing endless supplies of antibiotics home from work and feeding me on them.)

It was only very recently that I finally realised why in the early part of this century, when I was in the don't-care of psychiatrists, every time I hit rock bottom, they zombied me with anti-manic pills.  Bipolar + longwinded non-stop talking = manic.   No, for me, it's "My life's falling apart, people will say it's my fault, I need to explain why it's not."

Oh, that and the fact that when someone in authority like a doctor tells me to do something, I go into "Exactly what are the rules?  Exactly what is required of me?" mode, which is interpreted as 'concrete thinking' = mania or psychosis or both.

So for me, with stuff like memory tests, I think it's worth trying to clarify what you understand by the question and why your answer is what it is, but without being as longwinded as me. 
(I'm an obsessive problem-solver, so feel free to ignore any suggestions or solutions I offer, even if they sound terribly insistent.)

ditchdwellers

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Re: What's wrong with memory tests
« Reply #3 on: 14 Aug 2022 12:59PM »
This is interesting, and you raise a very valid point Sunny.


I think a lot of medical tests are too broad and a bit like using a sledgehammer to crack a nut.


Last time I was in hospital I was given a memory test. I laughed throughout the whole thing 🤣
It was early in the morning, I had just woken up when a doctor walked into my room (I was in my own room). He didn't introduce himself and proceeded to turn all the lights on full despite me telling him I had a migraine and hadn't taken my meds yet.
In my words I said "You'll have to excuse me, I'm a bit away with the fairies at the moment, can I have my meds and answer your questions later?"
Instead, he starts firing the memory test questions at me and I'm laughing because I know I'm getting all the answers wrong 🤣..


I repeatedly told him I have narcolepsy and it affects my cognitive ability first thing in the morning until I have my stimulants yet he wouldn't believe me.
So I got really cross, told him to bugger off, said he was rude, hadn't bothered to introduce himself, and didn't listen when I told him I had a migraine. Said he needed to improve his bedside manner, read patient notes thoroughly, and not jump to ridiculous conclusions.
He left, grumbling!


But I do feel that if I hadn't stood up for myself I would have ended up with a referral to the memory clinic.